Research Indicates Specific Systemic Drugs with Ocular Adverse Reactions

Long-term use of therapeutic agents has been on the rise in recent years. Consequently, the inadvertent effects of such use makes assessment of any adverse reactions important, and that’s exactly what is outlined in a new study appearing in the International Journal of Surgery as it pertains to ocular health and vision.The FDA Adverse Event Reporting System (FAERS) was used to look for ocular adverse reaction (OAR) reports from 2004 to 2024. After conducting a disproportionality analysis, it was found that most common OARs were cataract, dry eye and glaucoma with blurry vision, visual impairment and eye pain as leading symptoms. In total, 141 systemic drugs were identified and were found to span the following categories: antineoplastic medication (30 drugs), central nervous system meds (21 drugs), anti-infective drugs (15 drugs), immunological and inflammation-related therapy (15 drugs), cardiovascular drugs (10 drugs), endocrine and metabolic disease meds (10 drugs), respiratory therapies (six drugs) and other meds (34 drugs). Visual representation of the extent of different ocular adverse effects recorded in this study. Photo: Wu SN, et al. Int J Surg. October 14, 2025. Click image to enlarge. Among the antineoplastic drugs, belantamab mafodotin had the highest number of reports. The drug is used commonly for multiple myeloma, with previous studies noting that 79% of patients experienced blurred vision, 61% experiencing dry eye and 61% with foreign body sensation. However, among all drugs that had an associated OAR risk, the drug with the most reports was dupilumab, which is used for atopic dermatitis. Dupilumab-associated ocular surface disease is characterized by disruption of normal function and proliferation of conjunctival goblet cells needed to maintain the ocular surface with mucin. Consequently, the disruption results in reduced tear production, compromised ocular surface barrier function and development of symptoms like dry eye disease.The second-most reported drug was fingolimod, which treats multiple sclerosis; macular edema is already associated with this medication.With drug induction time, anti-infective drugs had a significantly shorter period than other drug categories. One of the drugs in this category is moxifloxacin, which is often used to treat infectious conjunctivitis with 0.5% drops. In this study, though, oral moxifloxacin was included and came along with a higher potential risk for uveitis. Accordingly, this highlights that different drug administration methods—even with the same drug—can have different adverse effects, which should be kept in mind in clinical practice. Conversely, endocrine and metabolic disease drugs had the longest OAR induction time, including insulin lispro and human insulin.The authors of the study believe that “by focusing on high-risk drugs and certain vulnerable populations, pharmacovigilance can help reduce the potential risks of systemic medication-related OARs, thereby assisting healthcare providers in making informed decisions when balancing the risks and benefits of medications for patients with multiple comorbidities.”They add that, “since ‘prevention is better than treatment’ for OARs induced by systemic medications, early identification of high-risk drugs is critical for pharmacovigilance assessment. By unveiling the OAR risk profile, onset patterns and potential mitigation strategies for systemic medications, this study lays a solid foundation for improving clinical decision-making and patient care in the context of drug-related ocular complications.”Click here for the journal source. Wu SN, Huang C, Chen XD, et al. Retrospective cohort study of ocular adverse events to systemic drugs: insights from a multi-country spontaneous reporting database. Int J Surg. October 14, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.